Recruiting more nurses is a key priority in delivering the modernisation agenda, according to Making a Difference, the national nursing and midwifery strategy.
1In July 1999 Birmingham Heartlands and Solihull trust had 8.5 per cent vacancies for trained nurses (equivalent to approximately 120 full-time posts).
This vacancy figure had been fairly static for more than two years and was showing no obvious signs of getting better. Implementing a D-grade development had meant that the trust was attracting newly qualified nurses from the local university.
2However, the two 'crops' of graduates each year would yield 30-40 new appointees at best. As the turnover rate was 10-15 nurses a month, this meant the number of vacancies would increase as the year went by unless a solution could be found. The increase in pre-registration commissions would yield a larger pool of local nurses in the future, but the two to three-year gap meant that action needed to be taken immediately.
The trust had previously recruited from overseas, with mixed success, and the retention rate for these nurses was poor, so the investment in time and resources was not cost-effective. Nevertheless, this looked the only option to improve the immediate situation. The trust decided to formulate a strategy to manage the recruitment campaign and ensure it was as effective as possible.
We had learned that recruiting international nurses was the easiest part - integration was more difficult. By addressing this problem in a variety of ways we managed to recruit 170 international nurses over six months, and successfully integrate and retain 166 of them.
The recruitment process A steering group was set up to manage the project, chaired by a senior nurse and supported by a project manager. The group included a finance adviser, a general manager, a practice and professional development representative, a nurse recruitment manager, a union/professional body representative, a communications director and a human resources representative. The remit of the group was to oversee the recruitment, retention and integration of all overseas nurses joining the trust, and to ensure that professional issues were addressed to avoid compromising patient care.
The first step was to let all key players know about the plans for recruitment, and to learn from other trusts' experiences. The Philippines was the main target for our recruitment, with over 70 nurses arriving throughout October. These nurses are not registered with the UK Central Council for Nursing, Midwifery and Health Visiting until they have completed an adaptation period in the UK.
This potentially meant a great deal of work for ward staff, who were already feeling hard-pressed and somewhat demoralised - a source of problems with previous overseas recruitment.
Managing their anxieties was crucial: taking ward managers to visit a trust which had recruited from the Philippines previously helped to allay their concerns and begin the process of gaining their support. Before the nurses arrived a great deal of thought went into planning for their needs, both personal and professional. Part of the agency's service included support from one of their employees - a nurse from the Philippines - who was an invaluable aid to cultural understanding.
It was vital that the nurses were made to feel welcome from the moment they came to us, and the project manager played a vital role in welcoming them, getting to know them all and being there to meet their needs, no matter what they were. The Roman Catholic chaplain was also involved and provided pastoral support (Catholicism is the majority religion). Professional education was required to enable them to become registered practitioners with the UKCC, and the project team designed and implemented their induction and adaptation programme. Additional guidance was delivered by two 'roving' assessors who were seconded from the wards.
This creative approach was instrumental in providing ward-based staff with vital support, particularly in the early days.
Keeping in touch with home Least anticipated was the positive impact of the nurses throughout the trust. Unsolicited comments were received from managers, doctors and patients about the success of the project, praising the skills and personal attributes of the individuals.
While expecting to learn from all the international recruits, we had not planned for the advanced computer literacy of the Filipinos compared to local nurses.
Access to the Internet was crucial for them, as it was a way of keeping in touch with home.We set up arrangements to meet this need, and soon saw the benefit: we frequently saw these nurses show their colleagues how to use the ward PCs.
Media interest had also been expected, but was difficult to manage, as negative coverage seemed to be the order of the day, and our experience was rapidly becoming positive. The production of Guidance on International Nursing Recruitment arrived a little late for our needs, and generated another bout of media interest.
3Fortunately, the guidance suggested avoiding South Africa and the Caribbean, but not the Philippines. We have recruited some staff from South Africa, but this was not central to our strategy, and will not form part of future campaigns.
We had expected the nurses to stay in hospital accommodation for some time, and were concerned that we would need to manage this in order to free rooms for new recruits as and when they arrived. But this difficulty did not arise: over 40 nurses moved out into the local community within four months. We thought it appropriate to make our legal support mechanisms available to oversee their rental and other agreements, to ensure any naivety was not exploited.
The adaptation was another pleasant surprise as we had planned for three to six months of intensive support and assessment, but most nurses passed their adaptation period within two to three months and were operating as registered nurses on the wards in time for peak winter activity.
There are now fewer than 2 per cent (19 full-time equivalents) vacant posts and most of these are E and F grade - international nurses will not fill this gap initially. Only four nurses have left so far (one Filipino only) and all the others seem keen to stay.
One has already achieved promotion to an E grade, and others look set to follow.
The turnover rate for all nurses continues to decrease and is at an all-time low. Morale is much improved on the wards, and positive media coverage has been experienced recently. We held an evening to celebrate the success of this project. We wanted to thank all the international nurses for their contribution to patient care, and for the difference they have made. Despite a clash with the England/ Portugal football match, there was a phenomenal turn-out.
Seeing our chair address each group in their own language, and perform the national Filipino dance, epitomised the success of the integration and the way our international nurses have become such a special part of our trust.
1 Making a Difference - strengthening the nursing, midwifery and health visiting contribution to health and healthcare: Department of Health, 1999.
2 Field A. Starters' Orders. HSJ 1998; 109: (5659).
3 Guidance on International Nurses Recruitment. Department of Health, 1999.